Provider Demographics
NPI:1679562748
Name:FRILOUX, MARK ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:FRILOUX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2001 AIRPORT RD N
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8827
Mailing Address - Country:US
Mailing Address - Phone:601-932-3191
Mailing Address - Fax:607-420-4375
Practice Address - Street 1:1503 HIGHWAY 45 N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2113
Practice Address - Country:US
Practice Address - Phone:662-328-9623
Practice Address - Fax:662-327-7477
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2007-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS10691207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118741Medicaid
MSB30663Medicare UPIN